Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK Kadoorie Critical Care Research Centre, Nuffield Department of Orthopaedic Surgery, University of Oxford, Oxford, UK.
Pain. 2012 Feb;153(2):494-501. doi: 10.1016/j.pain.2011.11.016. Epub 2012 Jan 9.
Group cognitive behavioural intervention (CBI) is effective in reducing low back pain and disability over a 12-month period, in comparison to best practice advice in primary care. The aim was to study the effects of this CBI beyond 12 months. We undertook an extended follow-up of our original randomised, controlled trial of a group CBI and best practice advice in primary care, in comparison to best practice advice alone. Participants were mailed a questionnaire including measures of disability, pain, health services resource use, and health-related quality of life. The time of extended follow-up ranged between 20 and 50 months (mean 34 months). Fifty-six percent (395 of 701) of the original cohort provided extended follow-up. Those who responded were older and had less disability and pain at baseline than did the original trial cohort. After 12 months, the improvements in pain and disability observed with CBI were sustained. For disability measures, the treatment difference in favour of CBI persisted (mean difference 1.3 Roland and Morris Disability Questionnaire points, 95% confidence interval 0.27 to 2.26; 5.5 Modified von Korff Scale disability points, 95% confidence interval 0.27 to 10.64). There was no between-group difference in Modified von Korff Scale pain outcomes. The results suggest that the effects of a group CBI are maintained up to an average of 34 months. Although pain improves in response to best practice advice, longer-term recovery of disability remains substantially less.
团体认知行为干预（CBI）在 12 个月的时间内有效降低了腰痛和残疾的发生率，与初级保健中的最佳实践建议相比。目的是研究这种 CBI 在 12 个月以上的效果。我们对我们之前的一项团体 CBI 与初级保健中的最佳实践建议的随机对照试验进行了扩展随访，与单独的最佳实践建议相比。参与者通过邮件收到了一份包括残疾、疼痛、卫生服务资源使用和健康相关生活质量的问卷。扩展随访的时间范围在 20 到 50 个月之间（平均 34 个月）。原始队列中有 56%（395/701）的人提供了扩展随访。与原始试验队列相比，那些做出回应的人年龄更大，基线时的残疾和疼痛程度更低。在 12 个月后，CBI 观察到的疼痛和残疾改善持续存在。对于残疾测量，CBI 的治疗优势持续存在（平均差异 1.3 分 Roland 和 Morris 残疾问卷，95%置信区间 0.27 至 2.26；5.5 分改良 von Korff 量表残疾评分，95%置信区间 0.27 至 10.64）。改良 von Korff 量表疼痛结果没有组间差异。结果表明，团体 CBI 的效果可维持长达平均 34 个月。虽然疼痛会因最佳实践建议而改善，但残疾的长期恢复仍然大大减少。
